tbuckley/cabot-search huggingface dataset:
Abstract 19115: In-situ Resuscitation Training in Cardiology Procedural Suites
Authors: Rahel Bahru, Brenna OConnor, JoAnn Daugherty, Anushirvan Minokadeh, Preetham Suresh
Journal: Circulation (2023)

Background: Critical Care Advanced Resuscitation Training (CC-ART) prepares critical care teams for emergency situations through training that occurs in a simulated clinical space. Simulated environments do not always accurately mirror the actual clinical environments. Simulations conducted in the actual clinical environment, also known as in-situ simulation, may overcome some of these challenges. Goal: To explored the impact of in situ, ART simulation in a Cardiac Catheterization Lab (CCL) and an Electrophysiology Lab (EPL) on the staff’s experience, confidence, and communication skills. Method: Key leadership and educator team members collaborated on the in-situ simulation set up. Coordination with Simulation Center and Central Supply Department was completed to arrange for delivery of high-fidelity manikins and training crash cart to the site. A team of physicians and nurse educators created CCL and EPL scenarios for the simulations and wrote a simulation evaluation survey for CCL and EPL nurses and technologists who attended. Results: . Simulations were run by both critical care anesthesiologist and clinical nurse educator. Pre-simulation and post-simulation surveys were collected immediately prior to and after the in-situ simulation. 38 staff completed pre and post surveys. Pre-simulation, 50.00% of staff strongly agreed that they were confident in their ability to care for a decompensated patient based on the prior CC-ART training versus, post-simulation, 84.21% strongly agreed. Pre-simulation, 26.32% strongly agreed that the simulation center training was similar to their actual work experience versus post-simulation, 78.95% agreed the in-situ simulation matched their actual work experience. Pre-simulation, 52.63% strongly agreed that they were confident in their ability to communicate their needs during emergencies or code blue situations versus post-simulation 86.84% agreed. Conclusion: This quality improvement project highlights the effectiveness of in situ resuscitation simulation in improving healthcare professionals' confidence, training realism, and communication skills . Analysis of patient outcomes is needed to determine the effectiveness and duration of impact of in situ training for clinical practice.
Abstract 16098: Cardiovascular Outcomes in Patients Hospitalized With Chronic Kidney Disease and COVID-19: A Nationwide Propensity-Matched Analysis
Authors: Abhiram Challa, Stephen Wanjala, Rhythm Vasudeva, Tejasri Polana, CYRUS MUNGUTI, Mohinder Reddy Vindhyal
Journal: Circulation (2023)

Introduction: There is limited data describing the cardiovascular outcomes in patients with coronavirus 2019 (COVID-19) and chronic kidney disease (CKD). This study aims to investigate the impact of CKD on cardiovascular outcomes in patients hospitalized with COVID-19. Goals: To assess mortality, readmission, and other in-hospital cardiovascular outcomes in COVID-19 patients with and without CKD. Methods: Patients &gt;18 years hospitalized with a diagnosis of COVID-19 were identified in the 2020 National Readmissions Database. Patients with CKD 3, 4 and 5 were subsequently identified using relevant ICD-10 codes. Nearest propensity score matching was conducted using a 1:1 ratio for several demographic, social, and clinical variables. Outcomes with &lt;10 cases were excluded per HCUP rules. Results: Amongst 5,831 COVID-19 patients identified, 599 had either CKD stage 3, 4 or 5. Baseline characteristics are shown in Table 1. After matching, CKD was associated with higher rates of acute heart failure (HF) and acute kidney injury (AKI). Our analysis did not find any significant differences in mortality or readmission rates. Conclusions: Our analysis found a higher rate of Acute HF and AKI among COVID-19 patients with CKD 3-5 compared to those without CKD. Additional studies are needed to further characterize this observation.
Abstract 19119: Predictors and Outcomes of Myocardial Infarction in Patients With and Without Takotsubo Cardiomyopathy
Authors: Aneeza Jamshed, Ayesha Abbasi, Ufuk Vardar, Sadichhya Karki
Journal: Circulation (2023)

Introduction: Takotsubo Cardiomyopathy often presents as acute myocardial infarction (MI) due to reversible cardiac dysfunction caused by catecholaminergic surge. Hypothesis: Is there any difference in the short-term outcomes of the patients who present with MI accompanied with Takotsubo cardiomyopathy when compared to MI alone. Methods:: National Inpatient Sample Database of 2016-2019 was queried for the Primary ICD code of MI and secondary as Takotsubo Cardiomyopathy. The in-patient mortality was the primary outcome whereas CVA, CHF and Arrythmias were considered as secondary outcomes. Results: Around 3million patients were discharged with MI per year, out of which 4% had Takotsubo Cardiomyopathy (TC). 65% of the patients in both groups were older than 65 years. The mean age of patients for TC with MI was 68 years as compared to 70 years in the MI group without TC. The inpatient mortality for the patients with MI and TC was 28% whereas for those with MI alone was 18% (p=0.000) with the aOR 2.4 (95% CI1.97- 2.93 p=0.00). Female gender is not significantly associated with odds of TC in MI (aOR:1.077 p= 0.401 95% CI: .90-1.28). The percentage of TC with MI was more in Black population (18%) as compared to MI alone (13%) with p=0.007. No difference in the mean Charlson index was found between the two groups (4.5 vs 4.2). Patients with MI and TC had higher odds of atrial arrythmias (36% vs 31% p=0.001) with a OR: 1.35 p=0.001 (95% CI: 1.13-1.63). TC was associated with lesser odds of CVA, CAD, HTN, CHF and DM in MI where there was no difference in smoking, dyslipidemias and other baseline factors. Patients with TC had a higher mean LOS 0.5 days. Conclusions: Takotsubo cardiomyopathy is associated with higher odds of in-patient mortality, mean LOS and Atrial Arrythmias in MI without any difference in age, comorbidity index and gender.
Abstract 19154: Impact of Personal ECG Monitoring on Health Care Resource Utilization
Authors: BENJAMIN GREEN, Carla L Zema, David E Albert, Amanda Althoff, Lawrence Rasouliyan, Drew Johnson, Daniel Frisch
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) monitoring is essential to optimize AF control, reducing the risk of adverse outcomes such as stroke. Traditional noninvasive monitoring options are limited to 30 days. KardiaMobile (KM) are medical-grade, personal ECG devices that record and detect common heart rhythm abnormalities over months to years. This study examined the use of KM to monitor AF and determine its impact on health care resource utilization (HCRU). Methods: This retrospective, observational study used anonymized administrative claims from 2017-2022 and linked to KM users with AF to compare their HCRU to AF patients that did not use KM. The index date for the KM group was the first device use after the first AF claim. The index date of the non-KM group was randomly matched. All-cause HCRU was identified within 1 year after index date. Results: A total of 243,450 AF patients were included with 121,725 in each group. The KM user group was similar to the comparison group in age (mean age 68.1 [SD=10.7] vs 69.1 [10.4]) and gender (62% males in both groups). The percentage of patients that had at least 1 outpatient visit was higher for the KM group (80% vs 64%, p&lt;0.0001), but lower for ER/urgent care visits (28% vs 30%, p&lt;0.0001) and lower for hospitalizations (16% vs 20%, p&lt;0.0001). Among patients with at least 1 hospitalization, KM users had nearly half as many hospitalizations as the comparison group (Figure, p&lt;0.0001). For those that had an ER/urgent care visit, KM users also had significantly less visits (Figure, p&lt;0.0001). Conclusions: AF patients that use a KM personal ECG are more likely to have outpatient visits but have fewer ER/urgent care visits and fewer hospitalizations than those who do not use KM. These results suggest that ER/urgent care and hospitalizations are reduced in AF patients who use KM. Figure. Comparison of utilization in the year following the index date for those with at least one visit in the category
3D Printed Photothermal Scaffold Sandwiching Bacteria Inside and Outside Improves The Infected Microenvironment and Repairs Bone Defects
Authors: Youzi Zhao, Honglei Kang, Yuhao Xia, Lingshun Sun, Feng Li, Honglian Dai
Journal: Advanced Healthcare Materials (2023)

Bone infection is one of the most devastating orthopedic outcomes, and overuse of antibiotics may cause drug-resistance problems. Photothermal therapy(PTT) is a promising antibiotic-free strategy for treating infected bone defects. Considering the damage to normal tissues and cells caused by high-temperature conditions in PTT, this study combines the antibacterial property of Cu to construct a multi-functional Cu
Abstract 12511: Efficacy of Bivalirudin versus Heparin Use on Clinical Outcomes Post Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials
Authors: Vikash Jaiswal, Akash Jaiswal, Marina Saleeb, Mayank Jha, Ananya Arora, Shiva Gupta, Endurance O Evbayekha, Amira Mohamed Taha, Song Peng Ang, Kendra J Grubb
Journal: Circulation (2023)

Background: For patients undergoing percutaneous coronary intervention (PCI), Bivalirudin has been shown to reduce major bleeding, however, unfractionated heparin is currently considered the standard of care. Objective: We sought to perform an updated meta-analysis comparing the efficacy of bivalirudin versus heparin undergoing PCI with the inclusion of the most recently published trials. Methods: A systematic literature search was performed in PubMed, Embase, and Clinicaltrial.gov from inception to 10th May 2023 for studies comparing bivalirudin vs. heparin among PCI-undergoing patients. Pooled odds ratios (OR) were calculated using a random effect model, and a p-value of &lt;0.05 was considered statistically significant. Results: A total of 14 randomized controlled trials with 35,533 patients (17765 in Bivalirudin treated group and 17768 patients in Heparin treated group). The pooled analysis shows that bivalirudin was associated with significant 21% reduction in net adverse clinical events (NACE) (OR, 0.79(95%CI: 0.71-0.88), P&lt;0.01), cardiovascular mortality (CVM) by 24% (OR, 0.76(95%CI: 0.65-0.90), P&lt;0.01), major bleeding by 36% (OR, 0.64(95%CI: 0.49-0.83), P&lt;0.01), transfusion by 42% (OR, 0.58(95%CI: 0.44-0.77), P&lt;0.01) compared to heparin. There was a trend of reduced all-cause mortality among bivalirudin groups (OR, 0.86(95%CI: 0.72-1.02) compared to the heparin group of patients, however, it didn't reach statistical significance. Incidence of stroke, major adverse cardiovascular events, myocardial infarction, and stent thrombosis was comparable between both groups of patients. Conclusion: Bivalirudin has shown to be superior to heparin among patients undergoing PCI with a reduction in bleeding, CVM, NACE, and a trend of reduced all-cause mortality.
Abstract 12557: Vericiguat Use in a Real-World HFrEF Patient Population: Two Years Post-Launch
Authors: Alejandro Victores, Lori D Bash, Boshu Ru, Ciaran J McMullan, Andra S Stevenson, James L Januzzi, Robert J Mentz
Journal: Circulation (2023)

Background: Worsening heart failure events (WHFE) affect up to one-third of patients with HFrEF. Vericiguat, the first agent indicated specifically for a WHF population, is a novel soluble guanylate cyclase (sGC) stimulator approved in 2021 to reduce the risk of cardiovascular death and HF hospitalization. Objective: To describe baseline characteristics, comorbidities, and comedication among patients on vericiguat therapy during the first two years after FDA approval. Methods: We identified adults in the TriNetX Open Claims Database who filled a prescription for vericiguat between 1 Jan 2021 and 24 April 2023. Summary statistics were computed describing patient and treatment patterns including those of other guideline-directed medical therapy (GDMT), stratified by record of achieving 10mg target dose. Categorical variables compared across groups using Pearson Chi-Square tests and continuous variables were compared across groups using non-parametric Kruskal-Wallis tests. Results: Among 5527 patients treated with vericiguat, mean age was 68 years, most were men (67%), and insured by Medicare (47%). Just over one third had a record of achieving the 10mg target dose before data cutoff. Other common GDMT used included beta-blockers (71%), ARNi (47%), MRA (38%) and SGLT2i (39%). Although comorbidities were similar between groups, use of these GDMT classes was statistically significantly higher among patients with a record of achieving target dose of vericiguat (P &lt; 0.05). Similar trends were observed among use of GDMT combinations based on record of achieving target dose (P &lt;0.002). Conclusions: Patients with a record of achieving vericiguat target dose were significantly more likely to be on other recommended GDMT and on GDMT combinations despite a similar comorbidity burden. Additional analyses are needed to better understand factors associated with patients reaching classes and target doses of GDMT, including vericiguat.
Abstract 12582: Predicting a Relationship Between Cancer and Cardiovascular Comorbidities by a Machine Learning Model
Authors: Sadaf Fakhra, Karthik Gonuguntla, Harshith Thyagaturu, yasar sattar, Ashley Armstrong, Aishwarya Bandaru, Thi Hoang Ngan, Brijesh Patel
Journal: Circulation (2023)

Introduction: Cardiovascular disease and cancer have previously been linked to share similar pathophysiological pathways, although these two entities are rarely studied in congruence. Method: We analyzed the 2019 National Readmission Database (NRD) and used unsupervised learning and K-means clustering for data analysis. We employed the Shapley Additive Explanation (SHAP) model to explain which features contribute the most to clustering. The final cohort was divided into four clusters guided by the Elbow method. Continuous variables were analyzed with Kruskal-Wallis test and reported as medians and interquartile ranges (IQR) after checking for normality test. We also performed sensitivity analysis on patients with cancer without applying a Boruta algorithm. Results: The final cohort includes 297,597 patients, and we randomly sampled 100,000 patients within divided into 4 clusters. The most prevalent types of cancer in clusters 1 were brain cancer (15%), prostate cancer (9.4%), non-Hodgkin’s lymphoma (8.7%), lung cancer (8.6%), and other specified and unspecified types of non-Hodgkin’s lymphoma (7.8%). Most prevalent cancers in cluster 2 were lung cancer (13.1%), prostate cancer (11.6%), breast cancer (8.5%), colon cancer (7.9%), and kidney cancer (5.5%). In cluster 3, lung cancer (15.6%), prostate cancer (9.3%), multiple myeloma (8.9%), lymphoid leukemia (7.6%), and other specified and unspecified types of non-Hodgkin’s lymphoma were more prevalent. Furthermore, in cluster 4, myeloid leukemia (27.7%), non-Hodgkin’s lymphoma (20.1%), multiple myeloma (14.8%), lymphoid leukemia (12.4%), and other specified and unspecified types of non-Hodgkin’s lymphoma (10.4%) were the most prevalent cancers. Patients grouped in Cluster 3 had higher percentages of cardiovascular risk factors and comorbidities such as hypertension, diabetes, hyperlipidemia, kidney diseases, and pulmonary hypertension. Cardiovascular outcomes were naturally more frequent in cluster 3. Conclusion: Although cardiovascular disease and cancer have previously been linked to share pathophysiology, our study emphasizes that commonality between two seemingly different diseases may all be secondary to shared underlying cardiovascular risk factors.
Abstract 16945: Aberrant Citric Acid Cycle Metabolites Temporally Coincide With Myocardial Dysfunction in a Rat Model of Stress Cardiomyopathy
Authors: Amit Iyengar, Noah Weingarten, Jessica Dominic, Danika Meldrum, Rachel Wilson, Andrew Belec, Joyce Ho, Melissa Seiberlich, Pavan Atluri
Journal: Circulation (2023)

Introduction: Stress cardiomyopathy is characterized by transient contractile dysfunction with a poorly understood mechanism. Targeting metabolic derangements has proven efficacious in chronic heart failure, but the role of metabolism in acute cardiac dysfunction is ill-defined. Hypothesis: Characterizing any metabolic alterations in stress cardiomyopathy may help identify potential therapeutic targets. Methods: Sprague-Dawley rats (350 ± 57 g) were given a single intraperitoneal injection of 75 mg/kg isoprenaline. Animals were allocated into groups (N=30 each) based on designated time-points for assessment after injection: control (no injection), day 1, 3, and 7. Rats underwent left ventricular PV loop catheterization followed by harvesting of apical ventricular tissue. Targeted metabolomic analyses were performed via LC-MS and supplemented with enzyme activity assays, qPCR, and Western blotting. Results: Stroke work, cardiac output, and ejection fraction were all significantly reduced by day 1 with recovery by day 7 (Figure A, all p&lt;0.05). Targeted tissue metabolomics revealed peaks in nearly all citric acid cycle metabolites, pyruvate, and lactate that similarly correlated with illness (Figure B). In tandem, anaplerotic amino acids rose with injury while tissue triglycerides decreased. Pyruvate dehydrogenase phosphorylation decreased with decreased expression of pyruvate dehydrogenase kinase (Figure C). However, no differences were noted in tissue acylcarnitine levels despite increased serum fatty acids (all p&gt;0.05). Conclusions: Profound rises in citric acid metabolites with accompanying increases in anaplerotic amino acids are suggestive of metabolic reprogramming in the setting of energetic deficits. Notably, these trends differ from those found in chronic heart failure, and represent a novel phenotypic characterization of stress cardiomyopathy with potential therapeutic implications.
Abstract 12522: Non-Ischemic Papillary Muscle Rupture Due to MRSA Myocarditis
Authors: Andrii Maryniak, Jiannan Huang, Filip Oleszak, David Maziarz, Tom P Stys, Adam Stys
Journal: Circulation (2023)

Case Presentation: A 46-year-old male with diabetes, ESRD, and recurrent MRSA bacteremia, presented with septic shock and suffered cardiac arrest. Following resuscitation EKG showed inferolateral ischemia. TTE revealed acute mitral valve regurgitation resulting from posteromedial papillary muscle rupture (PMR). An intra-aortic balloon pump was implanted for cardiogenic shock. Coronary angiography revealed right dominant circulation and thrombotic occlusion of a small caliber distal left circumflex artery (LCX). Emergent mitral valve replacement surgery was performed. Pathologic analysis of the excised muscle and leaflet showed marked acute inflammation, bacterial invasion, and myocyte necrosis, confirming non-ischemic rupture due to MRSA myocarditis. Discussion: PMR predominantly occurs after MI, complicating 0.03% of STEMI cases in the reperfusion era. Non-ischemic causes are rare. Coexistence of myocarditis, infective endocarditis (IE), and MI poses a challenge in determining etiology. Establishing causation guides whether to expedite emergent valve surgery or focus on cardiomyocyte salvage by revascularization. The posteromedial papillary muscle is most commonly involved in PMR due to single blood supply from the PDA (most commonly a branch of the RCA, and less commonly the LCX). Coronary angiography, postoperative histopathology, and culture results determined the etiology of PMR was fulminant MRSA bacteremia culminating in myocarditis. Bacterial colonization and resultant inflammation induced physical and mechanical strain leading to complete rupture. The occluded LCX was incidental, and may have been the result of septic embolization, which occurs in up to 65% of left-sided IE. Albeit rare, non-ischemic etiologies must be considered when the anatomic presentation of acute PMR on TTE is incongruent with angiography. Definitive treatment relies on surgical intervention and mechanical circulatory support is often necessary.
Abstract 12507: Impella versus Intra-Aortic Balloon Pump in Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Meta-Analysis
Authors: Vikash Jaiswal, Akash Jaiswal, Muhammad Hanif, Shiva Gupta, Endurance O Evbayekha, Vibhor Agrawal, Alla Sai Santhosha Mrudula
Journal: Circulation (2023)

Background: Acute myocardial infarction complicated by cardiogenic shock (AMICS) requires mechanical circulatory support, with IABP and Impella being commonly used options. The IABP's survival benefit is uncertain, and guideline recommendations differ. Studies comparing Impella and IABP have yielded mixed results and reported varying complication rates. Aim: This meta-analysis aims to comprehensively evaluate the effectiveness and safety of Impella versus IABP in AMICS. Methods: A systematic search was conducted in PubMed, EMBASE, Cochrane, and clincialtrials.gov from inception to April 2023 to identify studies comparing Impella and IABP in AMICS. A meta-analysis was performed to assess the short-term mortality as the primary efficacy endpoint, along with major bleeding, limb complications, acute kidney injury (AKI), stroke, and hemolysis as safety endpoints of interest. Results: A total of 10 studies (2 RCTs, 8 observational) with 6,634 patients were included in the final analysis. No significant difference was found in 30-day mortality (OR=1.03; 95% CI=0.74-1.42; p=0.87), in-hospital mortality (OR=1.14; 95% CI=0.45-2.85; p=0.79) and all-cause mortality (OR=1.00; 95% CI=0.55-1.81; p=0.99) between Impella and IABP. However, the analysis revealed a higher risk of major bleeding with Impella compared to IABP (OR=2.12; 95% CI=1.32-3.42; p=0.002) and an increased likelihood of limb complications (OR=3.86; 95% CI=1.57-9.48; p=0.003). There was no significant difference in the incidence of AKI (OR=0.91; 95% CI=0.56-1.48; p=0.70) and stroke (OR=0.72; 95% CI=0.42-1.24; p=0.24) between the two groups. Notably, the risk of hemolysis was significantly higher in the Impella group (OR=11.35; 95% CI=1.99-64.69; p=0.006). Conclusion: Impella and IABP showed similar short-term mortality, AKI, and stroke rates in AMICS patients. However, Impella was associated with a higher risk of major bleeding, limb complications, and hemolysis.